Anaesthesia and intensive care
-
Anaesth Intensive Care · Dec 2007
Randomized Controlled TrialA modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty.
We assessed whether a modified fascia iliaca compartment block in unilateral total hip arthroplasty provides a morphine-sparing effect in the first 24 hours. This involved a randomised, double blind study of 44 patients. Both groups received a modified fascia iliaca block with the trial group receiving 30 ml 0.5% bupivacaine with 1:200,000 adrenaline, 150 microg clonidine and 9 ml 0.9% saline and the control group receiving 40 ml 0.9% saline. ⋯ The median morphine usage at 24 hours was 37.5 mg in the control patients and 22 mg in the trial patients. Pain scores were similar between groups. We conclude that a modified fascia iliaca compartment block has a significant morphine-sparing effect in unilateral total hip arthroplasty.
-
Anaesth Intensive Care · Dec 2007
Randomized Controlled TrialThe influence of flushing epidural catheters before use on detection of intravenous placement: an in vitro and in vivo study.
Undetected intravenous placement of epidural catheters is rare but potentially fatal and no perfect identification method exists. Epidural catheters may be flushed before insertion to identify faulty epidural catheters, or to prime the system with local anaesthetic. We hypothesised that flushing epidural catheters before insertion may delay the detection of intravenous placement. ⋯ Blood flow to the 20 cm mark on the epidural catheter was significantly faster in the unflushed catheters than the flushed catheters, both in vitro and in vivo (in vitro, unflushed median = 18.6 s (range: 18.0 to 20.5 s), flushed 37.6 s (32.6 to 91.2 s), P = 0.0009; in vivo, unflushed 9.2 seconds (range 5.0 to 35.3 s), flushed 19.2 s (10.6 to 47.4 s), P = 0.003 in vivo). Flushed catheters also demonstrated a greater variability in the range of flowrates. Flushing epidural catheters before insertion may delay the detection of intravenous placement.
-
Anaesth Intensive Care · Dec 2007
Randomized Controlled TrialMethods of endotracheal tube placement in patients undergoing pelviscopic surgery.
Accidental endobronchial intubation is reported frequently during laparoscopic gynaecological surgery. We performed a prospective randomised study to compare three different methods of endotracheal tube placement in terms of susceptibility of accidental endobronchial intubation in patients undergoing laparoscopic gynaecologic surgery. The endotracheal tube was positioned by one of three methods: it was secured by palpating at the suprasternal notch while holding the pilot balloon (Group(Cuff)); by placing the 21 cm mark at the upper incisors (Group(21cm)); or by placing a guide mark, which was made on the surface of the tube 2 cm above the proximal end of the cuff at the level of the vocal cords (Group(VC)). ⋯ D(TC1) respectively) (all P < 0.01). Accidental endobronchial intubation occurred in 14%, with the lowest frequency in Group(VC) (2.6 %, P < 0.01) and the highest in Group(21cm), although this was not significantly (P = 0.09) different from Group(Cuff) (26.7% vs. 10.0%). The incidence of endobronchial intubation was lowest in Group(VC) but endobrochial intubation could not be avoided using any of these methods.